To date, data on the frequency of biofeedback in children of the first three years of life remain debatable. Obviously, the frequency of development of biofeedback depends not only on the age of the examined groups of children, but also on many other factors: environmental, social, etc. At the same time, the frequency of severe and / or recurrent variants of bronchial obstruction, usually requiring hospitalization and active drug therapy, is of most interest. The study of these indicators, taking into account their dynamics, is necessary both when planning the material and technical base of the children’s hospital, and in order to develop new methods for the diagnosis, treatment and prevention of diseases that occur with biofeedback.
We have studied the frequency and nature of bronchial obstructive syndrome among the entire contingent of young patients (from 3 months to 3 years old) hospitalized in the therapeutic (somatic and infectious) departments of the Morozov Children’s City Clinical Hospital (MDGKB) over the past decade. We evaluated the dynamics of statistical and clinical indicators in a retrospective analysis of statistical maps and case histories 1990, 1995 and 1999 This sample allowed us to objectively study not only the dynamics of the frequency of biofeedback according to the data of a large city hospital, but also to conduct an expert assessment of pre-hospital and clinical diagnoses in young children. In addition, a comparative analysis of 1999 indicators with data from previous years demonstrated the practical results of the implementation of the National program “Bronchial asthma in children. Treatment and Prevention Strategy ”adopted by Russian pediatricians in 1997.
As a result of the analysis, it was found that the frequency of biofeedback among hospitalized young children over the past 10 years has increased significantly and amounted to 9.7% in 1990, 12.3% in 1995 and 16.1% in 1999 (table 14 ) Given that MDGKB is a city hospital that provides both planned hospitalization and hospitalization of children delivered by ambulance, the identified trend most likely reflects a general increase in the frequency of biofeedback among young children. Moreover, as a rule, children with a rather severe course of biofeedback come to the hospital, while milder cases are treated at home.
The frequency of biofeedback in young children hospitalized at the Moscow City Children’s Clinical Hospital in 1990-1999.
|Year||Total young children||Young childrenwith biofeedback|
|3-12 months||1-3 years||Total with BOS||%||Of which BA||%|
The distribution according to the frequency of biofeedback at different times of the year showed that the peak of admission (35-40%) occurred in October, November and December, and children were most likely to be hospitalized for biofeedback in July and August.
An analysis was made by gender and age of all cases of biofeedback in children of the first three years of life (table 15).
Characterization of children with biofeedback by gender and age (n = 1138).
|Year||Floor||Age of Children with BFB|
|M||F||3-12 months||1-3 years|
It was revealed that about 1/3 of the studied group were girls and 2/3 – boys. The age distribution showed that the frequency of hospitalized children with biofeedback in different periods of early childhood is approximately the same for the period 1990-1999. did not change significantly.
It is known that biofeedback in young children often develops against a background of lower respiratory tract infection, but the literature on its frequency with this pathology is contradictory (13.62,108,123,171). We studied the frequency and nature of BFB in 99 young children (57 boys and 42 girls) who received treatment for a lower respiratory tract infection. A group of children was formed by the continuous sampling method. Acute community-acquired pneumonia was diagnosed in 40 children, and acute bronchitis in 59. In 32 (32.3%) children, biofeedback was observed, with bronchitis it was 3 times more common than with pneumonia (44% and 15%, respectively). In 18 (56.2%) patients with biofeedback, the first episode of bronchial obstruction occurred, of which 10 children were less than 1 year old. In 14 children (43.8%), BFB had a relapsing character, of which 2 children were aged 3 to 12 months (Table 16).
The frequency of biofeedback in children with lower respiratory tract infection aged 3 months to 3 years (n = 99).
|Acute bronchitis, n = 59||Acute pneumonia, n = 40|
|BOS I||BOS rec.||BOS I||BOS rec.|
BOS I – children with the first episode of bronchial obstruction
BOS rec. – children with recurrent course of biofeedback
Thus, biofeedback in young children admitted to the hospital for an acute infectious disease of the lower respiratory tract occurred in 1/3 of cases, and with bronchitis 3 times more often than with pneumonia. Repeated episodes of bronchial obstruction had a little less than half of the children, most of them were over the age of 1 year.
Of particular interest are data on the frequency of the established diagnosis of AD among young children with biofeedback. As our study showed, in 1999 the frequency of the established diagnosis of AD in young children who received treatment in the hospital for biofeedback compared with 1990 and 1995. increased by 2 times (table 14). This fact, on the one hand, may indicate a true increase in the frequency of AD among young children, and on the other, an improvement in the quality of diagnosis of AD. Of great importance was the National Program (58), adopted in 1997, which significantly contributed to the introduction of modern ideas about the pathogenesis of AD, the criteria for diagnosis, the basic principles of treatment and prevention of the disease.
It is known that biofeedback is a fairly heterogeneous group of diseases. The differential diagnosis of biofeedback at an early age has certain difficulties, at the same time, literature data indicate that AD debut is quite common in the first three years of life. The course and prognosis of AD largely depends on the timely treatment, adequate to the severity of the disease. Therefore, the diagnosis of AD established at an early age can improve the course and outcome of the disease.
In this regard, it seemed to us relevant to conduct a comparative analysis of the guiding diagnosis of children with biofeedback (i.e., the diagnosis of the prehospital phase) and the clinical diagnosis established in the hospital. We analyzed all cases of biofeedback in children aged 3 months to 3 years who were treated at the MDCH in 1999. The results of the analysis are presented in table 17.
We found that only in half of the patients the directing diagnosis coincides with the clinical diagnosis of the hospital. In addition, the syndrome of bronchial obstruction was not diagnosed at the prehospital stage in 275 (54%) children out of 508 children with biofeedback.
A serious discrepancy in the diagnosis, in our opinion, is the overdiagnosis of pneumonia. The diagnosis of pneumonia was a guide in 36 children with biofeedback, the examination conducted in the hospital confirmed this diagnosis only in 6 patients. The presence of dyspnea in children and physical signs of biofeedback in children with acute obstructive bronchitis at the prehospital stage were interpreted as signs of pneumonia.
A comparative analysis of the diagnoses revealed insufficient attention of pediatricians to the recurrent course of bronchial obstruction. Recurrent obstructive bronchitis was a rarity of prehospital diagnosis (0.59%), while the true frequency of recurrent bronchial obstruction was quite high (22.2% excluding children with AD).
35 children had a diagnosis of asthma as a guide, a clinical diagnosis of asthma was established in 99 patients, with 25% of patients having a severe course of the disease, 40% of children had moderate asthma, and only 35% of children had mild asthma. We believe that there are several causes of underdiagnosis of AD in young children. Firstly, the widespread belief that AD is not a disease of early childhood; secondly, to date, clear criteria for the diagnosis of AD in children of the first three years of life have not been developed; thirdly, the lack of objective methods for studying the function of external respiration in a small child; fourthly, the complexity of the differential diagnosis of recurrent bronchial obstruction.
An expert assessment of the guiding diagnosis showed that in some children the diagnosis did not correspond to existing classifications (for example, asthmatic bronchitis) or was unlikely (chronic obstructive bronchitis in children under 3 years of age is a rather rare disease). In addition, we combined some guiding diagnoses under the heading “others”: diabetes mellitus, episindrome, glomerulonephritis, tonsillitis, etc.
When analyzing concomitant pathology, we noticed that atopic dermatitis was detected in 74 children with obstructive bronchitis (in 18.3%) and in 27 children with AD (in 27.2% of cases). In addition, urticaria occurred in 2 children with acute obstructive bronchitis, 2 – Quincke’s edema, 1 – drug allergy, 1 – food allergy. The analysis shows that the concomitant pathology of an allergic nature is the most common in young children with biofeedback. Acute stenosing laryngitis (croup) syndrome was also often associated with biofeedback – in 15.4% of children, however, overdiagnosis of croup occurred in 4.7% (24 patients) of children with biofeedback.
Thus, biofeedback, according to a large city hospital, occurs in 16.1% of all hospitalized children aged 3 months to 3 years and in 32.2% of children with acute infectious diseases of the lower respiratory tract, and with bronchitis 3 times more often than with pneumonia. There is a clear tendency to increase the frequency of biofeedback; over the past 10 years, it has grown 1.8 times. Most often, children with biofeedback go to hospital in October-December. In boys, BOS is recorded one and a half times more often than in girls. The age distribution showed that in different periods of early childhood the frequency of hospitalization of children with biofeedback is approximately the same. The diagnosis of AD in young children in 1999 was established 2 times more often than in 1990 and 1995, however, an extremely rare diagnosis of AD in children of the first year of life is alarming, which does not correspond to numerous data from foreign literature. It cannot be ruled out that there was a hypodiagnosis of AD in children of the first 12 months of life.
A comparative analysis of the directing and clinical diagnoses has established that there is a discrepancy in the diagnoses in half of the patients. In children with biofeedback, overdiagnosis of pneumonia is often found, underdiagnosis of recurrent obstructive bronchitis and asthma, in half of the children, biofeedback is not diagnosed at the prehospital stage. Of the concomitant pathology , allergic diseases and croup syndrome are more likely to occur.
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